282 Foreiiiii Bodies in the Fore-stoinachs. 



The clinical picture of gastritis clue to pointed foreign 

 bodies is characterized by the sudden onset of the gastiic dis- 

 turbances without apparent cause, their variable character, 

 their obstinacy in their further course, tenderness in the region 

 of the ensiform cartilage and in certain cases at the attachment 

 of the diaphragm, and by the deficient use of abdominal pressure. 

 In the absence of the last mentioned symptoms a diagnosis is 

 hardly possible and it can be made only in the further course 

 of the disease, especially if heart symptoms develop and clear 

 up the nature of the disease. In the beginning of the latter an 

 exploratory abdominal puncture (behind the ensiform cartilage 

 between the navel and the milk vein) may perhaps throw light 

 on the case (Sallinger). If the foreign 'body is still sticking 

 in the gastric wall, or if acute inflammatory processes still 

 exist in the neighborhood of the perforated section of the 

 stoniach, the reaction of the fore-stomachs to the adminis- 

 tration of motor stimulants is decisive as first pointed out by 

 Johne. If these motor stimulants, causing strong contractions 

 of the stomachs also cause the expression of pain (groaning, 

 restlessness) with an intensification of the gastric disturbances, 

 one is justified in assuming the presence of a traumatic 

 gastritis (Johne, Eber, Holterbach). The absence of signs of 

 pain or the improvement of the condition after the administra- 

 tion of such drugs does not necessarily exclude the existence 

 of gastric disturbances of traumatic origin. 



Of the remedies which stimulate the gastric movements 

 tartar emetic or eseridine (see page 254 [Eber]) are par- 

 ticularly to be considered. Holterbach recommends veratrine 

 and arecoline (0.1 gm. in tablets) given in linseed broth alter- 

 nately every two hours. Veratrine may also be given subcu- 

 taneously with advantage, likewise pilocarpine (see page 254). 



In differential diagnosis certain cases of overfilling of 

 the rumen, acute bloating and atony of the fore-stomachs' due 

 to other caiises are to be considered. The important points 

 in differential diagnosis have already been mentioned (see 

 pages 252, 258, 27]). General acute peritonitis and gastritis 

 take an acute course with high fever, and grave general disturb- 

 ances; there are, however, cases in which even l:liese affections 

 cannot be absolutely exchided. Tuberculosis of the lungs can 

 be excluded if certain physical signs which may possil)ly point 

 to it, are only found in the posterior and lower portions of 

 the thorax, and perhaps only on one side, and if gastric dis- 

 turbances have preceded the preliminary affection. Sometimes 

 the tuberculin test may decide the question. Tuberculosis of 

 the mediastinal^ glands can easily be distinguished from 

 traumatic gastritis. — A compHcating pericarditis, pneumonia 

 or pleurisy might be confounded with tuberculosis. However, 

 secondary complications of traumatic gastritis are preceded by 

 gastric disturbances, and later they remain in the foreground 

 of the clinical picture. However, all circumstances must be 



